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DPT730: Physical Therapy Examination > Week 9 - Neurological Examination > Flashcards

Week 9 - Neurological Examination Flashcards

1
Q

When should a neurological exam be performed? (2)

A

If a positive myotome test occurs during an upper or lower quarter scan.

If patient reports a loss of feeling, numbness, or feeling during the history.

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2
Q

Based on the Guide to Physical Therapist Practice, what Test and Measurements are included with a neurological exam? (5)

A
  1. Cognition
  2. Cranial Nerve Integrity
  3. Pain
  4. Reflex Integrity
  5. Sensory Integrity
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3
Q

What are the various components of a nerological examination we can perform based on a patients history or results from a scanning exam? (6)

A
  1. Pain
  2. Sensory Examination
  3. Reflex Examination
    - Deep Tendon Reflex
    - Cutaneous Reflexes
  4. Motor Screen - Coordination
  5. Cranial Nerve Integrity
  6. Cognition (Mini-Mental State Exam)
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4
Q

If a patient reports pain during their history, what can be used?

A

a Visual Analog Scale (VAS) [100mm length line from 0 or None to Unberable or 100]

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5
Q

T/F: The VAS can be used to document pain at multiple times?

A

True

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6
Q

When can a patient document their pain level on a VAS?

A

Worst pain, least pain, pain level after activity vs before

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7
Q

What tool can be used to document a patient’s pain patter?

A

A Body Chart to graph/document location of PAIN and other sensory disturbances.

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8
Q

T/F: A Body Chart is done in discussion with the patient?

A

True

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9
Q

On a body chart, what symbol represents Stabbing pain?

A

///

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10
Q

On a body chart, what symbol represents Pins and Needles pain?

A

000

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11
Q

On a body chart, what symbol represents Burning pain?

A

XXX

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12
Q

On a body chart, what symbol represents Numbness pain?

A

===

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13
Q

What is a sensory examination guided by?

A

patient’s reporting “loss of feeling”, “numbness”, pins and needles”, “tingling”, or other subjective feelings of the patients.

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14
Q

How does a sensory examination usually begin?

A

with affected side, using unaffected side for comparison

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15
Q

before choosing a modality test, what might we have to conduct to confirm more specific locations and type of sensory loss?

A

Scanning Exam of Dermatomes

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16
Q

What do clinitians use to asses a potential sensory loss?

A

Dermatomal patterns

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17
Q

Define Dermatome

A

Area of the skin predominantly innervated by a single spinal nerve

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18
Q

In additional to dermatomes, a clinicion may want to if a sensory loss has occured over an area of the skin that is innervated by ___

A

a specific peripheral nerve (peripheral nerve fields)

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19
Q

How often and when is an entire body sensory examination performed?

A

rarely, a spinal cord injury would necessitate an entire body assessment of sensation

20
Q

If a patient does not report a sensory loss, IF a motor loss is observed in a peripheral nerve pattern, what should be done?

A

a sensory examination

21
Q

Sensory deficits are detected by

A

comparing the sensation between identical regions on two sides of the body

OR between proximal and distal regions of the same side of the body

22
Q

What constitutes as abnormalities in sensation?

A

Differences in the patient’s ability to perceive a sensory stimulus between body regions

OR a patients failure to detect a stimulus when applied

23
Q

Procedure

A
  1. The patient should be positioned so that all test areas are accessible
  2. The testing procedure should be explained to the patient before beginning the examination.
    - They need to know what you are going to do and how they should respond to the test.
    - Always demonstrate the sensory modality to be tested on an area of the patient’s skin with intact sensation, if possible
  3. The patient’s vision must be blocked during the sensory test
  4. Exam should start in areas of impaired or absent sensation and progress to areas of normal sensation
  5. Area of the patient’s skin where sensation is normal should be used as our comparison
    - May be opposite side of body OR a more proximal part of body (spinal cord injury)
  6. Sensory deficits should be carefully noted by examiner.
  7. Instruments used to test sharp-dull sensation should only be used on ONE patient
    - Either should be disposed of in sharps container or sterilized
24
Q

What are the three most common modalities that we use to assess sensation?

A

Sharp-Dull
Light Touch
Temperature

25
Q

What is used to assess Sharp-Dull sensation?

A

clean, unused safety pin

26
Q

What is used to assess Light Touch?

A

Wisp of Cotton or Finger Tips

27
Q

What is used to assess Temperature?

A

Assess using glass test tubes with crushed ice/water and hot tap water (outside of test tubes should be kept dry

28
Q

UQ Scan: C4 =

A

Lateral Acromium

29
Q

UQ Scan: C5 =

A

Mid Deltoid

30
Q

UQ Scan: C6 =

A

Radial border of forearm/thumb

31
Q

UQ Scan: C7 =

A

Distal middle finger

32
Q

UQ Scan: C8 =

A

Ulnar border of forearm/5th digit

33
Q

UQ Scan: T1 =

A

Medial border of arm

34
Q

LQ Scan: L1 =

A

Inguinal Area

35
Q

LQ Scan: L2 =

A

Anterior mid-thigh

36
Q

LQ Scan: L3 =

A

Medial Knee

37
Q

LQ Scan: L4 =

A

Medial Malleolus

38
Q

LQ Scan: L5 =

A

Distal medial dorsum of foot

39
Q

LQ Scan: S1 =

A

Lateral border of foot

40
Q

LQ Scan: S2 =

A

Medial / Posterior Calcaneus

41
Q

What is used to assess vibration?

A

128-Hz tuning fork

42
Q

T/F: Apply both non-vibrating and vibrating fork to patient

A

true

43
Q

Do you want to start proximally and move distally, or start distally and move proximally.

A

Start distally and move proximally

44
Q

What are the landmarks for testing vibration on the UE?

A
  1. Distal Phalanx Finger
  2. Ulnar Styloid Process
  3. Olecranon Process
  4. Acromion Process
  5. C7 Cervical Spinous Process
45
Q

What are the landmarks for testing vibration on the LE?

A
  1. Distal Phalax of Great Toe
  2. Medial Malleolus
  3. Patella
  4. ASIS
  5. Lumbar Spinous Process

DPT730: Physical Therapy Examination (9 decks)

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